Leading vaccinologist Professor Willem Hanekom has added his voice to those defending the government’s acquisition and rollout of Covid-19 vaccines, which has been criticised as “dismally slow”.
Hanekom, the director of the Africa Health Research Institute, was responding to last week’s upbraiding of the government by Professor Alex van den Heever, a health economist and chair of Social Security Systems Administration and Management Studies at the Wits School of Governance.
Van den Heever was a guest speaker in a webinar hosted last week by Medtalkz, an online medical education channel.
He said that South Africa’s Covid-19 death toll was triple the official 53 000 estimate. He is among about six medical scientists critical of the government’s decision to sell its 1.5-million AstraZeneca coronavirus vaccine consignment to other African nations.
One section of the scientific community cites the lack of local evidence for AstraZeneca efficacy against a moderate to severe variant of Covid-19 and the other cites overseas trials showing high efficacy against hospitalisation and death for other variants.
The so-called South African variant (the N501.V2 strain) has spread up Africa.
A local trial on a small group of younger people by Professor Shabir Madhi, dean of the faculty of health sciences at the University of the Witwatersrand and lead researcher of the AstraZeneca vaccine delivered on 1 February, found an AstraZeneca efficacy of just 10% against a mild to moderate case.
Madhi and five others called for South Africa to keep and use the AstraZeneca consignment to speed up the Johnson & Johnson (J&J) vaccine healthcare worker trial rollout. He said the AstraZeneca vaccine is safe and can be topped up with a different second vaccine without causing any harm.
Hanekom said Van den Heever and similar-minded researchers were guilty of using a “retrospectroscope” when a well-meaning government heeded expert scientific advice to make difficult calls in the face of fast-evolving threat.“Clearly, it’s been devastating economically, and we didn’t do a great job with vaccine procurement, but if you look at the second surge, our interventions worked on a far more transmissible strain which seems to cause more severe disease,” said Hanekom. “The government did the responsible thing by listening to scientists before deciding on the AstraZeneca batch – the question is what do we do now?”
Hanekom, like Professor Helen Rees, chief executive of the South African Health Products Regulatory Authority, and Professor Glenda Gray, chief executive of the South African Medical Research Council and J&J rollout leader, stressed the importance of public confidence in a vaccine.
“You have to bring society along with you and there is simply not enough data on the AstraZeneca vaccine. We just don’t know. Shabir [Madhi] may ultimately be right, but you can’t criticise the decision at the time,” he added.
Van den Heever said the government’s “inefficient” response to Covid-19 — a hard lockdown in March last year — was destructive to South Africa’s social and economic fabric and failed to prevent transmission.
He said the second wave response from late December proved far more effective in containing spread and did less economic harm.
“I don’t think we fully understood it [Covid-19], “ said Van den Heever. “It’s driven by super-spreader events. In the first surge the government didn’t accept that it’s an airborne epidemic — for example not warning against recycling air conditioned air or even enforcing mask-wearing in closed spaces. Taxis were not limited in numbers or advised to open windows. All this drove the surge.”
He said that when the second surge arrived from 27 December last year, different, less economically damaging restrictions were introduced such as limited gatherings, curfews and the closing down of liquor outlets and bars. A data sounding made between 11 and 13 January pointed to an infection decline in every province at about the same time.
“This suggests there is a configuration of non-pharmaceutical responses that will work and not completely destroy the economy,” Van den Heever said.
This, he said, begged the question of how many people had been infected so far and how much immunity had been conferred. Van den Heever believes that with the slow rollout of vaccines and a third infection wave possible, South Africa will have to rely on natural infection to supplement “behind the curve” vaccination and reach herd immunity.
In the hard-hit Eastern Cape, with its dismally managed healthcare system and infrastructure, he estimates that 60% of the population is already infected.
He added that without the South African Reserve Bank intervention, which created liquidity by buying up government bonds in secondary markets, the government would have been left without anyone willing to lend it money.
An impeccable government source at the heart of the AstraZeneca vaccine acquisition programme said the “real story” of the delay in acquiring vaccines involved deal terms that put obligations on South Africa to abide by certain regulatory terms and, more importantly, belated vaccine efficacy data.
“The first AZ [AstraZeneca] efficacy data was at the end of December – what other countries did was make financial commitments not knowing whether the vaccines worked or not and brought up to five times what they needed to hedge their bets. The reason we initially went with Covax was because the risk would be shared.
“So, instead, we waited until there was data [AstraZeneca’s 62.1% efficacy against the original Covid-19 strain, and 10% for a mild to moderate case of the variant]. Based on that original data, negotiations began,” the source said.